Introduction: Chronic kidney disease (CKD) represents a substantial economic burden, particularly in the Medicare population in the latter stages of disease progression. There are potential opportunities to provide quality care through population health management (PHM) interventions in the hopes of improving downstream outcomes and costs. In Kidney Coordinated HeAlth Management Partnership (CHAMP), a pragmatic, cluster randomized trial, patients received a PHM, multidisciplinary team approach to improve CKD care or usual care. The primary objective of this study was to conduct a post-hoc comparative analysis of the one-year healthcare utilization between patients who received the PHM intervention compared to usual care with a secondary objective of comparing standardized costs.

Methods: A subset of Kidney CHAMP patients who had available health insurance claims with enrollment for the full 12 months in the year following trial enrollment were included. Inpatient, outpatient, and pharmacy standardized costs were estimated using diagnosis-related groups, current procedural terminology, and National Drug Codes, respectively. Resource utilization was analyzed using negative binomial models and costs were analyzed using two-part models. All analyses were adjusted for demographic and clinical characteristics. Subgroups were analyzed by age, sex, CKD stage, and diabetes status.

Results: Of the 1,596 trial participants, 614 patients met inclusion criteria (PHM: 300; usual care: 314). Patients in the PHM arm had 27% fewer inpatient hospitalizations than usual care (incident rate ratio=0.73; 95% CI: 0.54-0.99), but outpatient visits did not differ significantly. Total standardized costs were similar between the PHM and usual care treatment arms across inpatient, outpatient, and pharmacy categories.

Conclusion: The PHM intervention reduced inpatient hospitalizations but did not significantly impact healthcare costs over one year. The reliance on standardized costs and the short follow-up may have obscured potential differences. Longer term data would help provide insight into the economic and resource utilization impact of the PHM intervention.

Copyright © 2025 by the American Society of Nephrology.

简介： 慢性肾病（CKD）在经济上带来了巨大的负担，特别是在疾病进展后期的医疗保险人群中。通过人群健康管理（PHM）干预措施提供高质量护理有可能改善下游结果和成本。在肾脏协调健康管理模式伙伴关系(CHAMP)中，一个实用、分组随机试验中，患者接受了以提高CKD照护质量为目标的多学科团队的PHM干预或常规护理。本研究的主要目的是进行事后比较分析，在接受PHM干预的患者与常规护理患者之间的一年医疗利用情况，并将标准化成本作为次要目的进行比较。

方法： 纳入了一部分具有完整12个月保险理赔数据并且在试验入组后一年内继续参与项目的肾脏CHAMP患者。住院、门诊和药店的标准化费用分别使用诊断相关分组、当前程序术语和国家药物代码进行估算。利用负二项模型分析资源利用率，并采用两部分模型来分析成本。所有分析均根据人口统计学和临床特征进行了调整。按年龄、性别、CKD分期以及糖尿病状态对亚组进行了分析。

结果： 在1596名试验参与者中，有614名患者符合纳入标准（PHM：300；常规护理：314）。PHM组患者的住院次数比接受常规护理的患者少27%（发生率比率=0.73；95% CI: 0.54-0.99），但门诊就诊没有显著差异。在住院、门诊和药店费用类别中，PHM与常规护理治疗组之间的总标准化成本相似。

结论： PHM干预减少了住院次数，但在一年内并未对医疗保健成本产生显著影响。依赖于标准化成本以及随访时间较短可能会掩盖潜在的差异。长期数据将有助于了解PHM干预措施在经济和资源利用方面的效果。

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